Sabrina Noel, PhD, RD is currently a Research Assistant Professor at the University of Massachusetts Lowell. She has advanced training in nutrition and epidemiology and experience working in both clinical and community settings. Dr. Noel's experience with diet and metabolic health research, and exposure to work with disparities in bone health, has encouraged her to pursue a career in population-based bone research. Her goal is to evaluate the effects of dietary quality on bone health and to develop a culturally and literacy-tailored behavior change intervention targeting dietary and physical activity behaviors among Caribbean Hispanic adults. In contrast to what has been earlier believed, Hispanics have recently been shown to have higher prevalence of osteoporosis, compared with non-Hispanic whites; however, most of this research has focused on Mexican Americans because of their majority status in the U.S. Hispanic population. Caribbean origin Hispanics are one of the fastest growing segments of the U.S. population and are underrepresented in bone- related research. Preliminary data from a large study of Puerto Rican adults in Boston, MA, indicates that Caribbean Hispanics are at higher risk for osteoporosis than previously thought. Identifying modifiable health behaviors, such as diet and physical activity, to prevent bone loss is an important public health priority, as adherence to bone medications is generally poor. Increasing evidence suggests that overall dietary quality is critical for bone health; however, studies that use predefined dietary patterns as a measure of overall dietary quality have reported inconsistent associations with bone outcomes. This is likely due to the fact that nutrients and foods known to be important for bone are underrepresented in these existing indices. We, therefore, propose to develop a bone-specific dietary quality index with nationally based data, and to then adapt it to include ethnic (Caribbean Latino) specific food choices related to bone health. Few theory-based interventions have targeted both dietary and physical activity behaviors to promote bone health and none that we know of have focused on overall dietary quality or on Caribbean origin Hispanic adults. This K01 award will provide Dr. Noel with training and research experience in bone health and osteoporosis prevention, health behavior theory, behavioral intervention design, implementation and evaluation, and advanced biostatistics. This training will help Dr. Noel achieve her long-term career goals of becoming a leading independent investigator in nutrition and bone health with expertise in designing and conducting culturally tailored behavioral interventions to improve bone health in diverse populations. Dr. Noel's mentors are highly committed to her career development and future success and will help her build additional knowledge and skills in bone health and intervention research. Dr. Noel's proposed research aims are to: 1) develop a bone-specific dietary quality index that emphasizes specific foods and nutrients known to be important for bone; and to evaluate the effects of a resulting dietary quality score on bone health using national survey data; 2) to adapt the index to include ethnic-specific food choices of Caribbean origin Hispanics, using data from an existing study of Puerto Rican adults, to guide the dietary component of a lifestyle behavior change intervention and; 3) to adapt and pilot test the feasibility and preliminary impact of a theory-based cultural and literacy-tailored intervention to improve dietary and physical activity behaviors among 60 Caribbean origin Hispanic adults. This bone-focused intervention will be modeled after another unique behavioral intervention, which successfully improved dietary quality and other health behaviors in low-income Caribbean Latinos. Innovative strategies, including narrative forms of communication, will be employed to help individuals adopt healthy behaviors. This work will inform a larger scale randomized controlled trial to evaluate the effectiveness of the behavioral intervention on bone outcomes in Caribbean Hispanics. This has the potential to have significant public health implications for improving bone health and preventing osteoporosis in high-risk, underserved ethnic minority populations.